Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994534 DEA: 010H1604 EFIS: 0117000117
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-R33.7/R43.2
Work Description: REPLACE AC SURFACING, PLACE HMA-A, RHMA-G & CONCRETE BARRIER.
Location Description: MENDOCINO COUNTY NEAR WILLITS FROM 1.1 MILES NORTH OF WEST ROAD OVERCROSSING TO 0.6 MILE SOUTH OF HAEHL CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 715 COMSTOCK STREET, SANTA CLARA CA 95054
Resident Engineer: Steve Tisell Structure Rep.: Unknown
DIME Sample ID: 2023-09-06-28
TL Number from the TL Form: 972004
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Department Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 09/06/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 can binder
A brief description of the sample: 1 can binder PG 58-22
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia
Performance Grade: PG 58-22
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
